Insomnia: When Is It Time for Prescription Medication?
There’s almost nothing worse than lying awake in bed at night, staring at the ceiling or flipping back and forth because you can’t sleep. You might start out by trying simple strategies like counting sheep or listening to a podcast or a guided meditation to help you wind down and fall asleep. Many people do well with some behavioral changes, but for others, it’s just not enough. If you need more help getting some shut-eye, you might consider a prescription medication for insomnia.
Everyone has the odd sleepless night here and there. Maybe you drank a little too much champagne at a wedding reception, or you ate a gigantic meal that induced some heartburn that kept you awake, or you’re dealing with some anxiety about a conflict at work. But the occasional bout of insomnia is different from persistent insomnia.
Are you regularly experiencing symptoms of ongoing or chronic insomnia? Here are some common symptoms to help you know for sure:
- Trouble falling asleep at night
- Frequently waking up at night
- Feeling tired after waking up
- Daytime fatigue or sleepiness
- Daytime concentration difficulties
- Waking up too early
Knowing what you’re dealing with may make it easier for you and your doctor to decide which future steps are most appropriate.
Many sleep experts will suggest that you try a few behavioral changes first. As the old expression goes, an ounce of prevention can be worth a pound of cure. These steps, or a combination of them, may help you get a good night’s sleep most nights so that you don’t have to proceed to medication:
- Stick to a regular sleep-wake routine, even on weekends
- Keep your bedroom cool and dark
- Skip or limit naps during the day
- Don’t eat right before bedtime, especially a large meal
- Limit or avoid caffeine, especially in the evening
- Avoid or limit alcohol consumption
- Get some exercise or physical activity on a regular basis at least 2 hours before bedtime
- Make sure none of the medications you’re taking contribute to insomnia
Your doctor may also suggest trying cognitive behavioral therapy for insomnia (CBT-I). In fact, CBT-I is often considered a first-line treatment for insomnia.
None of these methods are invasive. None have side effects. But they may have limited effectiveness for some people. So, if you’ve have tried all these strategies and you’re still tossing and turning all night, it might be time to ask your doctor about moving on to something else.
For some people, behavioral changes aren’t enough to beat insomnia. If you’ve given these behavioral changes a try but you’re still constantly tired, find yourself unable to perform your daily responsibilities, feel an impact on your mental health, or keep making dangerous mistakes, it could be time to talk to your doctor about medication. There are a few different kinds of drugs that are appropriate for treating insomnia. You could start out with an over-the-counter sleep aid or an antihistamine. Or your doctor might recommend treating your particular sleep disorder with a prescription medication.
When it comes to prescription sleep aids, benzodiazepines are one option. This is an older class of medications sometimes used to help people with chronic insomnia. These drugs include estazolam (Prosom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion). They’re effective, but some people feel pretty groggy the morning after taking one. Here’s another factor to consider: benzodiazepines can lead to dependence–and they’re more likely than newer meds to do so. You might very well experience some withdrawal symptoms when you attempt to stop taking them.
Another option? Medications sometimes called nonbenzodiazepines or “Z-drugs,” which include zaleplon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta). These medications slow brain activity so you’re better able to fall and stay asleep. They can also cause dependence, although it’s not as likely as with benzodiazepines. The Food and Drug Administration (FDA) also warns that in rare cases, these drugs can cause “complex sleep behaviors” that include sleepwalking, sleep driving, sleep cooking, or more. If you’ve experienced something like this, tell your doctor and avoid using Z-drugs.
A newer class of drugs, called orexin receptor antagonists, can help with insomnia and it’s thought they do not create a physical dependence. These medications, including suvorexant (Belsomra) and lemborexant (Dayvigo) affect the body differently than other insomnia drugs–they interfere with the body’s signals to stay awake, so you can fall asleep and stay asleep. Like other sleep aids, they can cause drowsiness the next day.
Other meds sometimes used to help people with insomnia include:
- Melatonin agonists
All of these medications have various potential side effects, so you and your doctor should carefully discuss what you’re hoping to achieve with medication and go over what meds are most likely to work well for you. Plus, your doctor will want to rule out other potential medical conditions that might contribute to your sleeplessness before recommending any medications. Medication may also not be appropriate for you if you have certain medical conditions, like kidney disease or liver disease.
Ultimately, it may come down to your own reaction to behavioral changes or CBT. Some people may decide they’re getting enough sleep without turning to medication. But if not, there are prescription sleep aids that might be worth a try.